15th Annual Conference of the British HIV Association 1-3 April 2009, Liverpool, UK

MULTICENTRE SURVEILLANCE STUDY OF HEPATITIS B VIRUS (HBV) INFECTION IN HIV-INFECTED PATIENTS: EVIDENCE OF TRANSMITTED AND ACQUIRED HBV DRUG RESISTANCE

HIV Med 2009 Apr 1-3 (Suppl 1);15:13 (abstract no. O29)

T Doyle
UCL Medical School, London, UK

BACKGROUND: HBV co-infection is common in HIV seropositive patients and, if poorly controlled, poses a risk of progressive liver damage.

OBJECTIVE: To assess the HBV virological status of co-infected patients in routine HIV care at 7 centres in England.

METHODS: Consecutive sAg+ patients attending for care in Jan-Jul 2008 were tested for HBV viral load (VL) by real-time PCR (LLQ 100 cps/mL). Current samples from patients with HBV VL >1000 cps/mL (n=47) and stored pre-treatment samples from patients with current HBV VL <1000 cps/mL (n=59) underwent HBV genotyping and resistance testing.

RESULTS: One hundred and eighty-seven patients were recruited with median age 42 years and CD4 count 401 (range 5–1240); 75% were males, 49% black Africans, 43% whites, 52% heterosexuals, 43% MSM, 86% on ART and 81% on anti-HBV drugs. HIV VL was <50 cps/mL in 66%. HBV DNA was detected in 61/187 (33%) patients with a median VL of 5744 (range 100–80 million) cps/mL. HBV viraemic patients included 36/151 (24%) patients on anti-HBV drugs with either combination therapy (n=27, median HBV VL 1,161,917 cps/mL) or monotherapy with 3TC (n=7, median HBV VL 1602 cps/mL), TDF (n=1, HBV VL 616 cps/mL), or ADF (n=1, HBV VL 369,926 cps/mL). Among 36 HBV viraemic patients, 23 had a HIV VL <50 cps/mL, including the 7 patients on 3TC alone. HBV resistance to 3TC was detected in 3/47 (6%) patients with HBV VL >1000 cps/mL, all on 3TC monotherapy. One other patient acquired acute 3TC-resistant [V173L, L180M, M204V] HBV infection while on 3TC as part of ART. Genotype distribution (n=106) was 69% A, 10% E, 9% D, 3% C, 2% F, 2% G, 1% B, 4% mixed.

CONCLUSIONS: HBV co-infection is mostly treated according to guidelines, with good virological responses. A subset of patients is on suboptimal therapy and at risk of HBV viraemia and drug resistance, despite well controlled HIV. A suppressed HIV VL should not be taken as evidence of HBV control. 3TC-resistant HBV is transmissible and pathogenic. There was a great variety of HBV genotypes in this cohort, consistent with its ethnic diversity.

2009-04-01
O29

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